Hepatobiliary surgery

Emergency referrals

All urgent cases must be discussed with the on call Surgical Registrar to obtain appropriate prioritisation and treatment. Contact through:

Royal Brisbane and Women’s Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000
Redcliffe Hospital (07) 3883 7777.

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1
Appointment within 30 days is desirable

Frequent biliary colic (more than weekly) not relieved by analgesia and lasting >8hours
Any suspicion of hepatobillary malignancy
Known gallstones with ongoing biliary colic
Gall bladder mass/recurrent cholecystitis
Radiological imaging abnormality requiring investigation

Category 2
Appointment within 90 days is desirable

Symptomatic gallstones
Gallstones (following cholecystitis, recurrent biliary colic)
Multiple gall bladder polyps
Chronic pancreatitis
Porcelain gallbladder

Category 3
Appointment within 365 days is desirable

Asymptomatic gallstones

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Primary care management and other important information for referring practitioners

Not an exhaustive list

Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
Referral is not mandatory for patient with asymptomatic gallstones
Short attacks of biliary colic can be managed symptomatically
Gallstones, points for concern:
- increasing frequency and severity of pain
- documented jaundice or deranged LFTs
- USS evidence of duct dilatation
- If known to have common bile duct stones refer as Cat 1
- If obstructive jaundice and fever – refer to emergency

Refer your patient

A referral may be rejected without the following information.

Patient information for this condition (essential)

History including:
- timeline of current symptoms and previous symptoms
- number of attacks and pain severity
- jaundice, anaemia
- abdominal examination (abdominal mass, palpable gall bladder)
FBC ELFT results
Serum lipase is performed, especially relevant if performed at the time of an attack of pain
USS/CT result (USS is required for Gallstone Disease)
HBV HCV serology results (if available)

Patient’s Demographic Details (essential)

Full name (including aliases)
Date of birth
Residential and postal address
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details (essential)

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature

Reason for Referral (essential)

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can’t order, or the patient can’t afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Clinical Information (essential)

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use